Características psicológicas associadas ao comportamento de fumar tabaco

Clinical study protocol on electronic cigarettes and nicotine pouches for smoking cessation in Pakistan: a randomized controlled trial

BACKGROUND

Pakistan is one of most vulnerable low- and middle-income countries with 29 million adult active tobacco users. Smoking cessation services are lacking as the tobacco control initiatives have largely failed to address the smoking endemic. Over the last 5 years, Pakistan has witnessed the use of innovative tobacco harm reduction (THR) products such as e-cigarettes and nicotine pouches. However, their use remains limited. THR products are imported legally as consumer goods and are taxable. The lack of sufficient data for THR and its application is a challenge in gauging their effectiveness in assisting smokers quit combustible smoking. Evidence-based studies can help in measuring the effectiveness of e-cigarettes and nicotine pouches as smoking cessation aids.

METHOD

Keeping in view the study objectives, a sample size of 600 participants will be sufficient to assess the effectiveness of e-cigarettes and nicotine pouches for smoking cessation in Pakistan. Of these, 200 participants each will receive e-cigarettes and nicotine pouches along with basic care counselling, while the remaining 200 participants will only receive basic care counselling for 48 weeks. The association of participants' characteristics with smoking and health status will be based on the bivariate and multivariate analysis. The simple t-test and variance analysis will assess the differences in intervention indicators between the control and treatment groups. For the inferential analysis, the average treatment impact will be based on the quasi-experimental techniques such as difference in difference (DID) or propensity score matching (PMS).

DISCUSSION

The study will evaluate the participants at the baseline as they decide the quit date. After every 12 weeks, a follow-up survey with the participants will be conducted. Results are anticipated to inform the public, decision-makers, and researchers about the effects of using e-cigarettes and nicotine pouches in the short- and medium-term periods. Critically, the potential of e-cigarettes and other alternative nicotine delivery systems as smoking cessation aid will be assessed.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05715164 . Registered on February 6, 2023.

PROTOCOL VERSION

Protocol version 1.0, 14-12-2022 Trial in progress and not yet recruiting participants. Estimated primary data collection date-April 2024.

Association between personality traits and smoking cessation among Chinese adults

BACKGROUND

Although the tobacco epidemic is one of the greatest public health threats, the smoking cessation rate among Chinese adults is considerably lower. Personality information may indicate which treatments or interventions are more likely to be effective. China is the largest producer and consumer of tobacco worldwide. However, little is known about the association between smoking cessation and personality traits in China.

AIM

This study aimed to examine the association between successful smoking cessation and personality traits among Chinese adults.

METHODS

This cross-sectional study used data from the 2018 China Family Panel Studies. Probit regression models were employed to analyze the association between successful smoking cessation and personality traits stratified by sex.

RESULTS

Lower scores for neuroticism (Coef.=-0.055, p < 0.1), lower scores for extraversion (Coef.=-0.077, p < 0.05), and higher scores for openness to experience (Coef.=0.045, p < 0.1) predicted being a successful male quitter after adjusting for demographics. Moreover, lower scores for conscientiousness (Coef.=-0.150, p < 0.1) predicted being a successful female quitter after adjusting for demographics.

CONCLUSION

The empirical findings suggested that among Chinese men, lower levels of neuroticism, lower levels of extraversion, and higher levels of openness to experience were associated with a higher likelihood of smoking cessation. Moreover, lower levels of conscientiousness were associated with successful smoking cessation among Chinese women. These results showed that personality information should be included in smoking cessation interventions.

Factors Predicting Dependence on Waterpipe Smoking Among Waterpipe Exclusive Smokers

ABSTRACT

The current study targeted a sample of waterpipe (WP) exclusive smokers to identify the levels and predictors of dependence on this smoking pattern and to examine the relationship between WP smoking (WPS) dependence and depressive symptoms. A cross-sectional research design was employed with a community sample of 270 subjects who are currently WP exclusive smokers. Assessment of WPS dependence and depressive symptoms was performed using self-report measures. About 62.6% of the subjects were WPS dependent. The unique significant predictors of WPS dependence were age, depression levels, age of starting WPS, duration of WPS, income, smoking WP daily, the belief of being attracted to WPS, and the desire to stop WPS. These predictors explained 35% of the variance in WPS dependence. WPS dependence was associated with increased depressive symptoms. Although few studies have been conducted, the WPS dependence prevalence appears to be alarmingly high among WP exclusive smokers. Factors associated with WPS dependence provide useful information that can be used to tailor WP prevention interventions.

Late-life drinking and smoking in primary care users in Brazil

To estimate the prevalence of at-risk drinking and smoking and associated factors among older adults in primary care in Brazil. A cross-sectional study carried out in seven primary care units with 503 older adults (60+), in a city in the state of Sao Paulo, Brazil. At-risk drinking was defined by AUDIT-C and by consumption of units per week. Poisson regression was used to assess the association between the sociodemographic and health characteristics and smoking and at-risk drinking. The median age of the 503 participants was 69.6 (SD ± 6.7; range:60-93). One third of participants (33.6%) were current drinkers, 16% were at-risk drinkers (AUDIT-C), 4% at-risk drinkers (units per week), and 13% of the sample were regular smokers. The prevalence of at-risk drinking (AUDIT-C) was higher for males (RP: 4.89; 95% CI: 2.52-9.49) and for those with higher levels of education (RP: 1,861.85 95% CI: 1.08-3.14), and lower for those over the age of 70 (RP: 0.50; 95% CI: 0.30-0.84). The prevalence of smoking was higher for those with depressive symptoms (RP: 1.95; 95% CI: 1.03-3.66), and lower for those over age 70 (RP: 0.52; 95% CI: 0.29-0.94). The results point to a set of factors associated with at-risk drinking (being male, younger and having a higher education), and with smoking (being younger and having depressive symptoms). Our findings could help health professionals to identify at-risk drinkers and smokers, as well as support strategies for future interventions by the identification of the groups most vulnerable to these behaviors.

Effectiveness of mobile applications to quit smoking: Systematic review and meta-analysis

INTRODUCTION

Tobacco is the leading cause of preventable mortality. The use of mobile phones has grown exponentially, becoming a powerful tool to be used in health care.

METHODS

In order to assess the effectiveness of mobile phones to quit smoking, we have carried out a systematic review and meta-analysis of randomized clinical trials evaluating interventions based on mobile applications for smartphones, that were not a smaller version of the same application, against other types of therapy. To address this, a bibliographic search was carried out in MEDLINE, EMBASE and COCHRANE LIBRARY. To obtain the combined effect, the relative risk and the 95% confidence interval were used. A heterogeneity and sensitivity analysis were also conducted.

RESULTS

A total of nine studies were identified, but five were excluded. Qualitative review was performed with four selected studies, but quantitative analysis was carried out for only three, given the impossibility of calculating the RR in one of the studies. After combining the results, an RR of 0.901 (95% CI: 0.57-1.423) was calculated comparing the effectiveness of mobile applications versus others type of interventions. This measure was robust, as shown by the sensitivity analysis.

CONCLUSIONS

According to the results, it cannot be concluded that apps are effective for quitting tobacco. There are very few clinical trials published evaluating the effectiveness of mobile applications compared to other alternatives. Several clinical trials are still in progress, therefore their results have not been included in the present meta-analysis.

Prevalence of disordered eating behaviors and associated factors in Brazilian university students

BACKGROUND

University students may be a vulnerable group to adopt unhealthy behaviors, including changes in eating behavior. Assessment of factors associated with the prevalence of disordered eating behaviors in this population may facilitate the early identification of their predictors, thus allowing fast interventions.

AIM

To analyze the prevalence of disordered eating behaviors (DEB) and associated factors in Brazilian university students.

METHODS

Cross-sectional study of male and female students aged 16-25 years, enrolled in full-time degree program at a public university in the mid-west of Brazil. Disordered eating behaviors in the last three months (binge eating, purging, and food restriction), through an adapted version of the instrument developed by Hay, was evaluated and the association with demographic and socioeconomic characteristics, including lifestyle, body image, perceived stress, depressive symptoms, and excess weight, was analyzed. A hierarchical analysis model was performed to determine the relative importance of factors on the prevalence of DEB.

RESULTS

A total of 1608 university students were evaluated (50.7% male). Prevalence of DEB was 4.4% for binge eating, 2.5% for purging and 9.1% for food restriction, all of which were higher among women (7.0%, 4.4%, and 13.5%) compared with men (1.8%, 0,6%, and 4.9%, respectively). The factors that remained significantly associated with these behaviors were female sex, smoking, consumption of alcoholic beverages, dissatisfaction with body image, excess weight, high perceived stress, and presence of self-reported depressive symptoms.

CONCLUSION

Factors associated with DEB signal that intervention is required to create synergy between individual and population-level interventions in lifestyle behaviors.

Barriers Affecting the Oral Health of People Diagnosed with Depression: A Systematic Review

Introduction

The problems of oral health of people diagnosed with depression are not adequately recognized, either in developed or developing countries. Social stigma, lack of self-interest, or even inadequate approaches of dental doctors towards the unique situation of this group of people this lead to excessive oral health problems.

Methods

The bibliographic database PubMed/Medline, Google Scholar, and Whiley online library were searched using the following text and MeSH as separate key terms and in combination: depression and oral health/dental caries/periodontal disease/tooth loss/utilization of oral health services/and barriers. The content of documents was analysed using qualitative methodology.

Results

Twenty-six original studies were included in the review. Level/severity of depression, medication and medical comorbidity are the most important medical barriers influencing the oral health of people diagnosed with depression. Dental fear and anxiety are mostly combined with low oral hygiene and bad oral health. Socioeconomic status, dental insurance, bad habits and education also have important roles in the oral health status of people diagnosed with depression.

Conclusion

Including individuals with depression and oral health problems in national health programs, creating specific prevention programs, or subsidizing the cost of treatment are some of the recommendations suggested as solutions.

Smoking cessation in Brazil: a survival analysis based on consumers' profile

Cigarette consumption is a worldwide epidemic and its reduction is one of the major public health concerns. In Brazil, although there is a wide literature on smoking cessation it is restricted to experimental studies. Based on data from the 2013 National Health Survey (PNS), this study uses the survival methodology and use population data and consumer's profile to investigate which characteristics will affect smoking cessation hazard. The results showed that the people who are less likely to quit smoking are older, single men, with low income and fewer education years. They also do not practice physical exercise. The findings of cigarette cessation hazard to Brazilian population are similar of experimental studies with smokers and ex-smokers in country. Therefore, in order to decrease public health spending, Brazilian health policies regarding tobacco cessation could focus on those groups who will likely smoke for a long time.

Islam and Motivation to Quit Smoking: Public Health Policy Implications

In the WHO Eastern Mediterranean Regional Office some 14 years ago, a 'religiously inspired approach' was proposed to combat tobacco use. This promoted a useful debate in the region. The purpose of this paper is to argue the need to identify the role which Islamic beliefs and teachings play (1) in influencing individual motivation to quit smoking and (2) in gaining support for public policies to reduce smoking. Ramadan and Hajj are taken as key points. These, it is argued, are times when Muslim religious motivation to abstain from smoking is strongest. This paper concludes that there is an insufficient evidence base on which to adopt a religiously inspired approach. All of civil society, including religious Muslim authorities, should rather supplement the efforts of health professionals to encourage smoking cessation.

Risk factors for depression in adults: NR3C1 DNA methylation and lifestyle association

OBJECTIVE

The aim of this study was to verify determinant factors for depression and analyze the relationship between possible changes in HPA axis and depression, in this case NR3C1 DNA methylation and serum cortisol levels.

METHODS

349 adult volunteers were recruited to evaluate depression, socio-demographic, economic and lifestyle factors, serum cortisol levels and NR3C1 DNA methylation by pyrosequencing. Depression determinant factors were investigated using a Poisson regression model with robust variance (p < 0.05).

RESULTS

Poisson regression with robust variance adjusted by gender, tobacco use, self-perceived stress, leisure activity, suicidal ideation, low cortisol levels and NR3C1 DNA methylation was performed and predicted risk factors for depression. Furthermore, depressive volunteers showed a significant increase in NR3C1 DNA methylation when compared to healthy volunteers.

CONCLUSIONS

This findings provide a basis for understanding the role of HPA axis in depression, especially its regulation by NR3C1 DNA methylation. Furthermore, it emphasizes the stressful lifestyle risk factors (female, tobacco uso, self perceived stress, leisure activities absence and suicidal ideation) that can contribute to future research and the search for public health policies to improve quality of live, mental and general health.

Environment and health: Risk perception and its determinants among Italian university students

Among the determinants of environmental health risk perception, health literacy and social media messages have been generally neglected. This study details the environmental health risk perception and its determinants in Italian university students, including a measure of functional health literacy and an analysis of newspapers and social media. A cross sectional survey was carried out among students from 15 Italian universities and different disciplines (grouped into Scientific-Health and Humanistic-Legal-Social sectors) using a self-administered anonymous questionnaire, divided into six sections: socio-demographic characteristics, information on health and environment, environmental health risk perception, trust, attitudes and behaviors and functional health literacy. Local newspapers and tweets in the same areas and period were analyzed in relation to quantity and topics. The study population included 4778 students (65.1% female) aged 21 ± 4.3 years, and functional health literacy was low (below the cutoff value) for 44.4% of students. A new outcome of the survey is that the detected association between high functional health literacy a higher global health risk perception and trust in institutions both as sources of information and as actors for protection against environmental risks. The internet and social networks were the most frequently consulted sources of information (77.7%), which was predictive of a higher risk perception. The possible relation between environmental health risk perception and tweet communication was highlighted by a comparison between the risk perception in the city with the highest number of tweets (Modena) and another one similar for socio-demographic characteristics (Pisa). In conclusion, the results of our study may be of help to strengthen information and education programs: functional health literacy should be taken into account in school programs, to produce a basic knowledge for a better understanding of health and environment. Moreover, mass and social media should be included in planning communication intervention and in verifying their results.

Prevalência de ansiedade e fatores associados em adultos

RESUMO Objetivo Identificar a prevalência de transtornos de ansiedade em uma amostra de base populacional e fatores associados. Métodos Estudo transversal de base populacional realizado com indivíduos entre 18 e 35 anos. As variáveis sociodemográficas, índice de massa corporal, presença de doença crônica, abuso de álcool e tabagismo foram analisadas. Os transtornos de ansiedade foram verificados pela Mini Internacional Neuropsychiatric Interview 5.0. Foi utilizado o teste Qui-quadrado, considerando o intervalo de confiança de 95%. Resultados A amostra foi constituída por 1.953 pessoas. A prevalência de transtornos de ansiedade foi de 27,4%. Agorafobia (17,9%) e transtorno de ansiedade generalizada (14,3%) foram os quadros mais prevalentes. Mulheres apresentaram maior prevalência de ansiedade, com 32,5%, quando comparadas aos homens (21,3%) (p < 0,001). As variáveis sexo, anos de estudo, renda, doença crônica, tabagismo e álcool foram associadas a mais de três transtornos de ansiedade investigados (p < 0,001). Conclusão Os dados demonstram que os transtornos de ansiedade são muito frequentes em adultos, sendo mais prevalentes entre as mulheres. Estão associadas aos transtornos ansiosos, principalmente, as condições socioeconômicas e substâncias licitas. Conhecer as prevalências dos transtornos de ansiedade e fatores associados pode auxiliar profissionais de saúde a elaborarem melhores diagnósticos e tratamentos.

Psychological factors associated with smoking and quitting: addiction map of Turkey study

BACKGROUND

Smoking is the most important modifiable factor in increased morbidity and premature mortality. This study aims to examine the psychological factors associated with smoking and quitting in a broad, nationally representative sample.

PARTICIPANTS AND METHODS

The sample included a total of 24.494 adult individuals. Participants were divided into three groups as smokers, non-smokers, and "ex-smokers" who had stopped smoking since at least last one year. For the current smokers, cigarettes per day also noted. Brief Symptom Inventory, Toronto Alexithymia Scale (TAS), Personal Well-Being Index Adult Form, Positive and Negative Affect Schedule, Experiences in Close Relationships-Revised Scales were used.

RESULTS

43.6% (n=10,672) of the participants were smokers; 5.7% (1386) were ex-smokers; 50.7% (n=12,414) were non-smokers. A higher number of daily smoked cigarettes was related to all subscales of Brief Symptom Inventory, TAS - Difficulty in Recognition of emotions, TAS - Difficulty in Expressing Emotions, Positive Affect Score, Negative Affect Score, Avoidance and Anxious Attachment scores (p<0.05). Externally oriented thinking is found to be significantly higher among ex-smokers than current smokers and non-smokers (p<0.05).

CONCLUSION

The results of the present study indicate that smokers have more psychopathological characteristics in the psychometric evaluation, whereas ex-smokers are found to have similar scores to non-smokers. The higher percentage of externally oriented-thinking style in ex-smokers may suggest that this alexithymic characteristic can help the individual to deal with psychological addiction throughout quitting. On the other hand this result could also be related that stopping smoking leads to greater externally orientated thinking and other changes in psychological characteristics.

Prevalência de depressão e fatores associados em mulheres atendidas pela Estratégia de Saúde da Família

RESUMO Objetivo Avaliar a prevalência de depressão e os fatores associados em mulheres de 20 a 59 anos de áreas cobertas pela Estratégia de Saúde da Família de município da Zona da Mata Mineira. Métodos Trata-se de um estudo transversal, com mulheres de 20 a 59 anos cadastradas em duas Unidades de Saúde da Família, que utilizou um questionário contendo variáveis sociodemográficas, apoio social, autoavaliação de estado de saúde, estilo de vida, morbidade e saúde da mulher. O desfecho depressão foi avaliado segundo o Patients Health Questionnaire-9 (PHQ-9). Resultados Das 1.958 mulheres incluídas nesta análise, 28,5% encontram-se na faixa etária entre 30 e 39 anos; 15,4% não concluíram o ensino elementar; 54,5% não trabalham ou nunca trabalharam; 44,2% declararam não ser da raça branca. Fatores associados à ocorrência de depressão na população estudada: possuir baixa escolaridade, trabalhar atualmente e ter doença mental prévia. Como fatores de proteção observaram-se: ser casada ou viver com companheiro, realizar atividades físicas regularmente e relatar autoavaliação positiva de saúde. Conclusão Os resultados deste estudo revelam prevalência de depressão de 19,7% nas mulheres de 20 a 59 anos de áreas cobertas pela Estratégia de Saúde da Família, apontando para a necessidade de um cuidado especial na atenção primária à saúde às mulheres com baixa escolaridade, que trabalham, apresentam doença mental e não praticam exercícios físicos, de modo que se possa reduzir o sofrimento e promover a saúde. Ressalta-se a lacuna na utilização de instrumentos de rastreamento dos casos de depressão na atenção primária.

Quality of life and associated characteristics: application of WHOQOL-BREF in the context of Primary Health Care

This study aimed to identify the characteristics associated to quality of life (QOL) in users of four Basic Health Units (Unidades Básicas de Saúde, UBS) in Belo Horizonte, Minas Gerais. We conducted a cross-sectional study with 930 adult users enrolled in the selected UBS, using a questionnaire containing the WHOQOL-bref instrument and questions about sociodemographic characteristics, lifestyle and health conditions. Following descriptive analysis, we performed simple and multiple linear regression to evaluate the association between the exposure variables and the QOL domains. The highest mean values of QOL were observed in the social relationships domain. The lowest means were observed in the environment domain, with a statistically significant difference between some of the UBS. The worst perceptions of QOL were related to worse health, housing, education and income conditions, as well as problems in social relationships and psychological conditions. Actions are needed to improve QOL in Primary Health Care users through actions promoted by both health professionals and public managers.

The association between smoking and psychopathology adjusted for body mass index and gender

OBJECTIVE

This study examined the correlation between smoking habits and psychopathology status, as well as the impact of confounders such as body mass index and gender.

METHOD

A total of 134 non-smokers and 152 smokers were enrolled in this study. We measured psychopathology features using Symptom Checklist 90-Revised. We ran logistic regression models testing the smoking-psychopathology association, controlling for body mass index and gender.

RESULTS

Smoking was positively correlated with depression, interpersonal sensitivity, hostility, somatization, paranoid ideation and psychoticism (P<0.05). Adjusting for body mass index and gender, the results remained largely unchanged, with a slight independent effect of body mass index.

CONCLUSIONS

Our data suggest that smoking is a stronger predictor of psychopathology than body mass index and gender.

Affective temperaments in nicotine-dependent and non-nicotine-dependent individuals

<b>Background</B><br /> One of the smoking risk factors influencing nicotine dependency may be human personality; however, few studies have examined the association between Akiskal’s affective temperaments and smoking in adults. Our study aims to evaluate the associations between nicotine dependence and affective temperaments using the TEMPS-A.<br /> <br /> <b>Participants and procedure</B><br /> The sample in this study consisted of 678 healthy Caucasian adults aged from 17 to 69 years, including 134 self-declared nicotine-dependent subjects (89 females and 45 males) and 544 self-declared non-nicotine-dependent subjects (352 females and 192 males). The Polish version of the Temperament Evaluation of Memphis, Pisa, Paris and San Diego Autoquestionnaire (TEMPS-A) was used to assess affective temperaments (depressive, cyclothymic, hyperthymic, irritable and anxious).<br /> <br /> <b>Results</B><br /> Nicotine-dependent individuals scored higher on cyclothymic, irritable and anxious temperaments than non-nicotine-dependents (no significant differences with regard to depressive and hyperthymic temperaments). Among the nicotine-dependent individuals, females scored higher on anxious temperaments than males (no differences with regard to the other affective temperaments), and among the non-nicotine-dependent individuals, females exhibited more depressive, cyclothymic and anxious temperaments than males, while males exhibited more hyperthymic temperaments than females.<br /> <br /> <b>Conclusions</B><br /> The results suggest that affective, cyclothymic and irritable temperaments in both genders and anxious temperaments in females may be predictors of nicotine dependence in adults.

The association of depression and anxiety with dental caries and periodontal disease among Finnish adults

OBJECTIVE

To explore the association of depression and anxiety with two oral health outcomes, dental caries and periodontal disease and assess possible mediators for any of the associations.

METHODS

Secondary analysis of the Finnish Health 2000 Survey. Depression was assessed with Beck's Depression Inventory and anxiety with Composite International Diagnostic Interview. Number of decayed teeth included carious lesions reaching dentine; periodontal disease was number of teeth with periodontal pockets of 4 mm or deeper. Third molars were excluded. The association of mental disorders and oral health was tested in regression models adjusted for confounders and potential mediators.

RESULTS

Depression was associated with number of decayed teeth only among 35- to 54-year-olds. The association between anxiety and the number of decayed teeth was not statistically significant. Depression and periodontal pocketing were not significantly associated.

CONCLUSION

Depression was significantly associated with number of decayed teeth only among participants aged 35-54 old and not with other age groups. Neither depression nor anxiety was significantly related to periodontal disease.

Ansiedade e baixo nível motivacional associados ao fracasso na cessação do tabagismo

Objetivo Analisar a associação entre as características sociodemográficas, status do tabagismo, grau de motivação, nível de ansiedade, depressão e de estresse com o fracasso em pacientes de um programa de cessação de tabagismo. Métodos Estudo de corte transversal realizado com pacientes que procuraram os programas de cessação do tabagismo de Cuiabá/MT, Brasil. Todos os fumantes matriculados no início desses programas, durante o período de maio a agosto de 2012, foram convidados a participar deste estudo, totalizando 216 pacientes. Os instrumentos utilizados foram o questionário Perfil Sociodemográfico, Teste de Fagerström (FTND), URICA, Inventário de Ansiedade de Beck (BAI), Inventário de Depressão de Beck (BDI) e Inventário de Sintomas de Stress de Lipp (ISSL). Os dados foram digitados duplamente em programa Epidata versão 3.1, e para análise dos dados foi utilizado um modelo de regressão de Poisson. Resultados Foram encontradas associações do fracasso terapêutico com as seguintes variáveis: faixa etária jovem (RP = 1,68; IC 95% 1,11-2,56); menor tempo de tabagismo (RP = 1,32; IC 95% 1,09-1,61); maior consumo de cigarros/dia (RP = 1,24; IC 95% 1,01-1,52) e menor grau de motivação (RP = 1,55; IC 95% 1,04-2,30). No modelo final (RPa), ficaram associadas ao fracasso as variáveis: menor tempo de tabagismo (RPa 1,53; IC 95% 1,07-2,32), maior carga tabágica (RPa 1,48; IC 95% 1,12-1,95), baixo nível de motivação (RPa 1,58; IC 95% 1,07-2,32) e alto nível de ansiedade (RPa 1,22; IC 95% 1,01-1,48). Conclusão Baixo nível motivacional (Contemplação e Pré-contemplação), alto nível de ansiedade (moderado/grave), menor tempo de tabagismo e alta carga tabágica estão associados ao fracasso terapêutico.

A systematic review of baseline psychosocial characterisation in dietary randomised controlled trials for weight loss

BACKGROUND/OBJECTIVE

To investigate the extent of baseline psychosocial characterisation of subjects in published dietary randomised controlled trials (RCTs) for weight loss.

SUBJECTS/METHODS

Systematic review of adequately sized (n ≥ 10) RCTs comprising ≥ 1 diet-alone arm for weight loss were included for this systematic review. More specifically, trials included overweight (body mass index >25 kg/m(2)) adults, were of duration ≥ 8 weeks and had body weight as the primary outcome. Exclusion criteria included specific psychological intervention (for example, Cognitive Behaviour Therapy (CBT)), use of web-based tools, use of supplements, liquid diets, replacement meals and very-low calorie diets. Physical activity intervention was restricted to general exercise only (not supervised or prescribed, for example, VO2 maximum level).

RESULTS

Of 176 weight-loss RCTs published during 2008-2010, 15 met selection criteria and were assessed for reported psychological characterisation of subjects. All studies reported standard characterisation of clinical and biochemical characteristics of subjects. Eleven studies reported no psychological attributes of subjects (three of these did exclude those taking psychoactive medication). Three studies collected data on particular aspects of psychology related to specific research objectives (figure scale rating, satiety and quality-of-life). Only one study provided a comprehensive background on psychological attributes of subjects.

CONCLUSION

Better characterisation in behaviour-change interventions will reduce potential confounding and enhance generalisability of such studies.

Can an index of smokers' emotional status predict the chances of success in attempts to quit smoking?

Smoking cessation still is a great challenge for smokers and health care professionals. Most subjects try cigarettes in adolescence under predominant environmental influences, and some psychological features are clearly associated with the establishment of continuous cigarette use. As a result, it is acceptable to assume that the risk of becoming regular smokers should be higher for subjects exhibiting imperfect psychological well-being. Since nicotine exhibits recognized psychopharmacological actions, an important reason for smoking would be the comfort of smokers' emotional afflictions. In this scenario, cigarettes might be seen as effective coping instruments for smokers. We hypothesize that a simple measure covering major emotional features of smokers might become a useful instrument for predicting the chances of success in attempts to quit smoking. The development of this new test aimed to measure the degree of smokers' emotional imbalance has the potential to predict the chances of success in response to standard therapy, as well as the need for introduction of intensive individualized psychological or psychiatric interventions. Preliminary analyses of a new test called Smokers' Emotional Index (SEI) support such a hypothesis. The SEI scores showed significant correlations with the values of the Fagerström test of nicotine dependence (FTND) for adult smokers. More numerous and better correlation coefficients were also observed between aspects of smoking history with SEI punctuations than with FTND scores. A clinical trial is proposed to test this hypothesis that could help to improve the results of current approaches to smoking cessation.

[Factors associated with smoking in the elderly: a health survey in São Paulo (ISA-SP)]

This article reports on smoking prevalence and associated factors in the elderly, based on a population-based cross-sectional study with multi-stage sampling including 1,954 individuals 60 years or older living in four areas of São Paulo State, Brazil. Overall smoking prevalence was 12.2%, and higher rates were associated with male gender, age 60-69 years, not belonging to an Evangelical church, lower income, low body weight, lack of leisure-time physical activity, depression/anxiety, and hypertension. There was a high prevalence of smokers among individuals with a history of stroke, cancer, and chronic obstructive pulmonary disease. The results point to the need for effective interventions in healthcare services to promote smoking cessation among the elderly, since many are unable to stop on their own, even when they have tobacco-related illnesses. Special attention should be paid to individuals that depend on the National Health System, since smoking prevalence is higher in underprivileged socioeconomic groups.

Personality typology in relation to muscle strength

BACKGROUND

Physical inactivity plays a central role in the age-related decline in muscle strength, an important component in the process leading to disability. Personality, a significant determinant of health behaviors including physical activity, could therefore impact muscle strength throughout adulthood and affect the rate of muscle strength decline with aging. Personality typologies combining "high neuroticism" (N ≥ 55), "low extraversion" (E < 45), and "low conscientiousness" (C < 45) have been associated with multiple risky health behaviors but have not been investigated with regards to muscle strength.

PURPOSE

The purpose of this study is to investigate associations between individual and combined typologies consisting of high N, low E, and low C and muscle strength, and whether physical activity and body mass index act as mediators.

METHOD

This cross-sectional study includes 1,220 participants from the Baltimore Longitudinal Study of Aging.

RESULTS

High N was found among 18%, low E among 31%, and low C among 26% of the sample. High levels of N, particularly when combined with either low E or low C, were associated with lower muscle strength compared with having only one or none of these personality types. Facet analyses suggest an important role for the N components of depression and hostility. Physical activity level appears to partly explain some of these associations.

CONCLUSION

Findings provide support for the notion that the typological approach to personality may be useful in identifying specific personality types at risk of low muscle strength and offer the possibility for more targeted prevention and intervention programs.

Prevalência e perfil dos usuários de tabaco de população adulta em cidade do Sul do Brasil (Joaçaba, SC)

O tabagismo tem sido apontado como uma epidemia, e a prevenção ao hábito é indicada como prioridade máxima para a saúde pública das nações. Este é um estudo do tipo observacional e transversal envolvendo uma amostra representativa da população adulta de município do sul do Brasil com o intuito de conhecer a prevalência do consumo do tabaco e o perfil do tabagista. A prevalência de fumantes foi de 17,3%, sendo que o sexo feminino representou 54,9% da amostra. Neste estudo, o tabagismo ocorreu predominantemente em pessoas com idade superior a 39 anos (p<0,001), com escolaridade de até oito anos de estudo (p<0,001), com índices de depressão verificados pelo Inventário de Beck para Depressão considerados como moderado ou grave (p=0,001) e com baixa renda familiar (p<0,029). O município apresenta alta prevalência de consumo de tabaco, que afeta, predominantemente, a população acima de 39 anos de idade, com menor renda e com menor escolaridade. Este estudo evidencia ainda uma associação entre depressão moderada a severa e o hábito do tabagismo.

Emotional and affective temperaments and cigarette smoking in a large sample

BACKGROUND

Tobacco use has been associated with externalized personality traits. Our aim was to evaluate the association of smoking with emotional and affective temperaments in a large sample.

METHODS

In this cross-sectional web-based survey, volunteers completed the Combined Emotional and Affective Temperament Scale (CEATS), which assesses emotional (fear, drive, anger, and control) and affective temperaments (e.g. cyclothymic, irritable), and questions about smoking.

RESULTS

Among the 5379 subjects (1370 males), there were 60% non-smokers, 17% quitters and 23% current smokers. Non-smokers had higher fear and control and lower anger than quitters and smokers, and higher drive than smokers. Quitters had higher drive and control and lower anger than smokers. Smoking was lower among apathetics, depressives, euthymics and hyperthymics and higher in cyclothymics and labiles. Lower drive and higher anger were associated with heavier smoking. Less adaptive temperament was related to higher prevalence of and heavier smoking.

LIMITATIONS

The data was collected from a convenience sample by the internet, and most volunteers assessed the instrument through a psychoeducational website for bipolar spectrum disorders, leading to a higher proportion of cyclothymics; the assessment of smoking habits was limited to two questions; the study was cross-sectional.

CONCLUSIONS

Smoking was associated with lower fear, control and drive, higher anger and unstable externalized affective temperaments. Lower control and higher anger were associated with being a heavy smoker and current smoking. Assessment of temperament may help decision about treatments for smoking cessation.

Smoking and depression: Is smoking cessation effective?

Patients with depression tend to have a higher rate of smoking and an increased severity of nicotine dependence. It seems that common genetic and environmental factors may influence the bimodal relationship between smoking and depression. Nicotine has some positive reinforcing/rewarding effects that may affect people with mood disorders and smoking is also used as a ;relief medication' in order to ameliorate symptoms of depression, as it is already known that nicotine, which is the major psychoactive ingredient in tobacco, may act as an antidepressant. To date, the data regarding the difficulty in smoking cessation in depressed smokers are conflicting. Low confidence and self-esteem among this group of smokers are significant predictors of failure during smoking cessation attempt. In the most recently published guidelines for smokers with psychiatric comorbidities the suggestion is for combination treatment (counseling and pharmaceutical treatment) and prolongation of a therapeutic approach.